Organ Allocation Waiting Time During Extracorporeal Bridge to Lung Transplant Affects Outcomes
Organ Allocation Waiting Time During Extracorporeal Bridge to Lung Transplant Affects Outcomes
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DOI：
10.1378/chest.12-1141
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发表时间：
2013-09-01
期刊：
影响因子：
9.6
通讯作者：
Gattinoni, Luciano
中科院分区：
文献类型：
--
作者：
Crotti, Stefania;Iotti, Giorgio A.;Gattinoni, Luciano
背景资料：使用体外膜肺氧合（ECMO）作为桥梁肺transplant.Methods的（LTX）仍在争论：我们进行了一项回顾性的两个中心的分析25例患者的ECMO桥接时间和生存之间的关系。通过根据ECMO等待时间将患者分为14天（早期组）或更长时间（晚期组）来获得进一步的生存分析。我们还分析了ECMO桥接期间通气策略的影响（即自主呼吸和无创通气[NIV]或插管和有创机械通气[IMV]）。结果：25例患者中有17例接受了移植（1年生存率为76%），而8例患者在桥接期间死亡。在17例接受移植的患者中，死亡率与等待LTX的天数呈正相关（风险比[HR]，1.12/天; 95% CI，1.02-1.23; P=.02），早期组显示出更好的Kaplan-Meier曲线（P= 0.02），更高的1年生存率（100% vs 50%，P= 0.03）和更低的发病率（IMV天数和ICU和医院住院时间）。在移植桥期间，死亡率随着时间的推移而稳步上升。考虑到桥接方案的总体结局（25例患者），桥接持续时间对生存率（HR，1.06/天; 95% CI，1.01-1.11; P= 0.015）和1年生存率（早期，82% vs晚期，29%; P= 0.015）有不利影响。死亡率指数较低的患者接受NIV治疗在bridge.Conclusions：ECMO桥的持续时间是一个相关的辅助因素，危重患者等待器官分配的死亡率和发病率。NIV策略与LTX后较不复杂的临床病程相关。
Background: The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (LTX) is still being debated.Methods: We performed a retrospective two-center analysis of the relationship between ECMO bridging duration and survival in 25 patients. Further survival analysis was obtained by dividing the patients according to waiting time on ECMO: up to 14 days (Early group) or longer (Late group). We also analyzed the impact of the ventilation strategy during ECMO bridging (ie, spontaneous breathing and noninvasive ventilation [NIV] or intubation and invasive mechanical ventilation [IMV]).Results: Seventeen of 25 patients underwent a transplant (with a 76% 1-year survival), whereas eight patients died during bridging. In the 17 patients who underwent a transplant, mortality was positively related to waiting days until LTX (hazard ratio [HR], 1.12 per day; 95% CI, 1.02-1.23; P=.02), and the Early group showed better Kaplan-Meier curves (P=.02), higher 1-year survival rates (100% vs 50%, P=.03), and lower morbidity (days on IMV and length of stay in ICU and hospital). During the bridge to transplant, mortality increased steadily with time. Considering the overall outcome of the bridging program (25 patients), bridge duration adversely affected survival (HR, 1.06 per day; 95% CI, 1.01-1.11; P=.015) and 1-year survival (Early, 82% vs Late, 29%; P=.015). Morbidity indexes were lower in patients treated with NIV during the bridge.Conclusions: The duration of the ECMO bridge is a relevant cofactor in the mortality and morbidity of critically ill patients awaiting organ allocation. The NIV strategy was associated with a less complicated clinical course after LTX.